febrile Seizure.

1. DR.ABHINAV MAHESHWARI
Febrile Seizure

2.  Seizure :- A seizure is a transient occurrence of
signs and/or symptoms resulting from abnormal
excessive or synchronous neuronal activity in the
brain.
 Epilepsy:- It is a disorder of the brain characterized
by an enduring predisposition to generate seizures
and by the neurobiologic, cognitive, psychological,
and social consequences of this condition.

3. Febrile seizures
It is the most common neurologic disorder of infants
and young children.
They are seizures that occur
 age of 6 and 60 months (peak 12-18 mo)
 temperature of 38°C (100.4°F) or higher,
 Absense of CNS infection
 Absense of any metabolic imbalance
 No history of prior afebrile seizures.

4.  simple febrile seizure
 complex febrile seizure
 febrile status epilepticus
 febrile infection–related (or refractory) epilepsy
(FIRES)
 generalized epilepsy with febrile seizures plus
(GEFS+)
 severe myoclonic epilepsy of infancy
 Dravet syndrome

5.  simple febrile seizure
Primary generalized, usually tonic-clonic,
attack associated with fever,
lasting for a maximum of 15 min,
no recurrent within a 24-hr period.
 complex febrile seizure
more prolonged (>15 min),
and/or is focal,
and/or recurs within 24.

6.  Febrile status epilepticus is a febrile seizure
lasting longer than 30 min.
 Febrile infection–related (or refractory )
epilepsy (FIRES) is a very different disorder seen
predominantly in older (>5 yr) usually male children
and associted with an encephalitis-like illness but
without an identifiable infectious agent.

7. Risk Factors for Recurrence of Febrile
Seizures
 MAJOR
 Age < 1 yr
 Duration of fever < 24 hr
 Fever 38-39°C (100.4-102.2°F)
 MINOR
 Family history of febrile seizures
 Family history of epilepsy
 Complex febrile seizure
 Daycare
 Male gender (1.6:1)
 Lower serum sodium at time of presentation
No risk factors recurrence 12%; one risk factor, 25–50%; two risk
factors, 50–59%; three or more risk factors, 73–100%.

8. RISK FACTOR RISK FOR SUBSEQUENT
EPILEPSY
 Simple febrile seizure 1%
 Recurrent febrile seizures 4%
 Complex febrile seizures 6%
 Fever < 1 hr before febrile seizure 11%
 Family history of epilepsy 18%
 Complex febrile seizures (focal) 29%
 Neurodevelopmental abnormalities 33%

9.  Generalized epilepsy with febrile seizures
plus (GEFS+) is characterized by multiple febrile
seizures and by several subsequent types of afebrile
generalized seizures, including generalized tonic-
clonic, absence, myoclonic, atonic, or myoclonic
astatic seizures with variable degrees of severity

10. Dravet syndrome
 It is the most severe of the phenotypic spectrum of febrile
seizure–associated epilepsies.
 onset in infancy.
 Initially characterized by febrile and afebrile unilateral clonic
seizures that recur every 1 or 2 month.
 They are more prolonged, more frequent, and focal and recur
in clusters.
 Seizures subsequently start to occur with lower fevers and
then without fever.
 During the second year of life, myoclonus, atypical absences,
and focal seizures occur frequently and developmental delay
usually follows.
 Mutations in the SCN1A gene are the most common cause of
Dravet syndrome

11. vaccine encephalopathy
 majority of patients who had prolonged febrile
seizures andencephalopathy after vaccination and
who had been presumed to have suffered from
vaccine encephalopathy.
 Turn out to have Dravet syndrome mutations,
indicating that their disease is caused by the
mutation and not secondary to the vaccine.

12. Evaluation

13. Lumbar Puncture
 Meningitis should be considered in the differential
diagnosis.
 Lumbar puncture should be performed for all infants
younger than 6 mo of age who present with fever and
seizure.
 lumbar puncture is an option in a
 child 6-12 mo of age deficient in Haemophilus
influenzae type b and Streptococcus pneumoniae
immunizations
 children who have been pretreated with antibiotics.

14. Electroencephalogram
 EEG need not be performed as part of the evaluation
in first simple febrile seizure and is otherwise
neurologically healthy child.
 EEG would not predict the future recurrence of
febrile seizures or epilepsy even if the result is
abnormal.
 An EEG is indicated, it is delayed until or repeated
after more than 2 wk have passed.
 It should be used to delineate the type of epilepsy
rather than to predict its occurrence.

15. Blood studies
 They are not routinely recommended in the workup
of a child with a first simple febrile seizure.
 Blood glucose should be measured.
 Serum electrolyte values may be abnormal in
children after a febrile seizure, but this should be
suggested by precipitating or predisposing
conditions elicited in the history and reflected in the
physical examination.

16. Neuroimaging
 A CT or MRI is not recommended in evaluating the
child after a first simple febrile seizure.
 The workup of children with complex febrile seizures
needs to be individualized.

17. Treatment
 In general, antiepileptic therapy, continuous or
intermittent, is not recommended for children with one
or more simple febrile seizures.
 If the seizure lasts for longer than 5 min, acute treatment
with lorazepam, midazolam, or diazepam is needed.
 Buccal or intranasal midazolam may be used.
 In cases of frequently recurring febrile seizures,
intermittent oral clonazepam (0.01 mg/kg every 8-12 hr
up to a maximum dose of 1.5 mg/day) or oral diazepam
(0.33 mg/kg every 8 hr) can be given during febrile
illnesses.
 Use of continuous therapy is not justified, due to the risk
of side effects and lack of demonstrated